Knocked Out

Natasha Helmick goes up for a header during a Dallas soccer match and gets speared in the left temple by an opponent. The 14-year-old, a talented center midfielder playing in the choice Lake Highlands Girls Classic League, crumples to the ground.

She can't see anything out of her left eye. Her coach asks if she's okay, Natasha lies and says she's good to go and the coach puts her back into the lineup. She plays the remainder of the game, even though one eye sees darkness while floaters and sparkly objects dance in front of the other.

Natasha plays again later that day, sans full eyesight. Her vision will eventually return, but five years and four concussions later, Natasha Helmick is unable to recall much of her childhood.

When speaking to her, you wouldn't know that Natasha, who was forced to give up an athletic scholarship to Texas State University-San Marcos, is a brain-damaged 19-year-old. "But academically," says her mother, Micky Helmick, "everything is three times harder."

As Natasha racked up more concussions, David Goldstein, a "little freshman" by his own estimation, shouldn't have even been on the soccer pitch during the January 2010 district finals for Ransom Everglades, a Miami, Florida-area prep school, against longtime rival Gulliver. But when an older kid was injured, David subbed in, and was playing one of the best games of his life when he collided head-to-head with an opponent he describes as "a monster from Gulliver."

Game tape shows David holding his head and swaying like a drunk. But there was no way he was going to take himself out of this match, and his coach didn't either.

It was — though David didn't understand the medical ramifications at the time — his third concussion in four years. After the game, he felt nauseous and cowed by light, stumbling to his dad's car and collapsing.

For months, the "blaring" headache persisted. "It's always there," he describes. "It's so intense, it takes over your life." Previously a devoted student, David took refuge in the school nurse's office three hours each day, closing his eyes to the painful light. He became agitated and impatient with his friends. Every specialist his parents took him to was perplexed by his condition.

Across the country, people have awakened to the sometimes irreversible damage of concussions, especially in high-impact professional sports. With much of the attention focused on the National Football and National Hockey leagues, the Houston Press — following a months-long, nationwide investigation into the consequences of concussion on youth athletes, who are bigger and more aggressive than in past generations, and often play year-round — has found the following:

• The effect of a concussion on kids can be much more devastating than on adults. Doctors say that until a person is in his early to mid-20s, his brain is not fully developed and can't take the same level of trauma as an adult brain can.

• Postmortem analysis, the only surefire way to measure concussions' devastating effects, shows that repeated blows to the head may be linked with Alzheimer's, Parkinson's, ALS and a number of other fatal diseases.

• An athlete who doesn't exhibit outward signs of a concussion (headaches, dizziness, vomiting, temporary amnesia) can still experience changes in brain activity similar to those in a player who has been clinically diagnosed with a concussion.

• Thus far in 2011, 20 state governments and the District of Columbia have signed concussion legislation that prohibits an athlete from returning to play until cleared by a licensed physician. To date, 28 states (as well as the city of Chicago) have concussion laws in place. This does not include Florida, whose legislators struck down a proposed bill that could have helped protect youth athletes.

• The ImPACT test, widely regarded as the go-to neurological exam to measure concussive blows, doesn't always accurately gauge a player's readiness to return to action. And you can cheat on it.

Meanwhile, as attorneys debate how the new concussion laws will play out, kids like Natasha Helmick, whose memory struggles sometimes resemble those of an elderly person, continue to battle a condition that puts parents who want the best for their children in an interesting position: Would they push to have them be standouts in athletics — sometimes the key to a better future — if they realized that in some cases, their kids can be harmed for life by their participation in elite sports?

The answer is "no" for Hall of Fame quarterback Troy Aikman, who says, based on his own concussion episodes, that he will never allow his kids to play a contact sport.
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For Ali Champness, it was a freak ball kicked into her face by her own goalie in practice that turned her life upside down. The 14-year-old freshman, who'd already made junior varsity at Garces Memorial, a Catholic high school in Bakersfield, California, told her parents the sting went away after a little while.

Two days later, though, on the way to a game, recalls her mother, Kim Champness, Ali complained of a headache and dizziness.

During play, the ball was kicked in the air and "brushed across the front of [Ali's] face," says Kim. "It was not a hard hit at all, but right after that, she started stuttering." Ali saw a doctor, who discovered a number of much more serious problems.

In the past, a "bell ringer" was thought of the same way as a cut or a sprained ankle, with no lasting side effects. Until a few years ago, the NFL's medical committee on concussions published studies that concluded players were not suffering long-term damage from head trauma incurred during athletic competition.

The lack of awareness carried over to the training rooms of every sport, and high-profile athletes such as boxer Muhammad Ali and All-Pro safety Dave Duerson were prematurely sent back into action. Years later, they essentially lost their minds. (The Centers for Disease Control and Prevention estimates that as many as 3.8 million sports- and recreation-related concussions occur each year. Out of this figure, about 235,000 persons are hospitalized and 50,000 die per annum, according to the CDC.)

"Ninety percent of concussions went undiagnosed," Chris Nowinski of the Boston-based Sports Legacy Institute tells the Press. "In fact, today you can talk to an athlete and ask the amount of concussions they've had and give them the actual definition, and that number will increase."

Nowinski, a former World Wrestling Entertainment pro and author of Head Games: Football's Concussion Crisis, along with noted neurosurgeon Dr. Robert Cantu, founded the Sports Legacy Institute. The foundation works with Boston University's Center for the Study of Traumatic Encephalopathy in performing post-death pathology on brains donated by former athletes.

One of the latest specimens examined was that of Duerson, a former NFL standout who, following years of dementia and depression, shot himself to death — in the chest so his brain would be preserved — on February 17. Neurologists later confirmed that Duerson, who had played for the Chicago Bears, New York Giants and Phoenix Cardinals (now called the Arizona Cardinals), was afflicted with chronic traumatic encephalopathy (CTE), a neurodegenerative disease linked to the total amount of distress a brain receives during a lifetime. Because a concussed person may not always exhibit classic symptoms such as headaches and nausea, CTE is, in essence, an invisible killer that can cause the brain of a 35-year-old to resemble that of an 80-year-old.

These findings have helped turn the National Football League from concussion skeptics into an organization that is spreading the word that head trauma in sports can have deadly consequences. The campaign has even trickled down to the NFL-licensed Madden NFL video games, in which a concussed player in the yet-to-be-released Madden NFL 12 cannot return to play after suffering the injury. In February, the league urged all states to pass concussion legislation in youth athletics.

For the 75 former NFL pros who sued the league in July, alleging it concealed the dangers of the injuries for decades, it's too little, too late. Football retirees such as Mark Duper, Ottis Anderson and Raymond Clayborn are claiming that the league was careless in its false assumptions. (As of press time, the NFL planned to contest the allegations.)

The proper treatment of concussions, especially in youth sports, is still a developing — and somewhat murky — science.

In 2004, Jake Snakenberg, a Denver-area high school freshman, knocked his head during a football game but assured his mother he felt ready to play again. A week later, the young fullback once again hit his head during a game.

The blow was unremarkable, but Jake staggered to his feet and fell back down. He never got back up, and was declared dead the next day from second-impact syndrome, a swelling of the brain derived from a second concussion before the symptoms of the first have passed.

These types of injuries are exacerbated in youth athletes because the human brain doesn't metabolically or neurochemically mature until a person is in his or her early to mid-20s, according to David Hovda, professor and director of the University of California-Los Angeles' Brain Injury Research Center (see "Knocked Out: Bell Ringing"). This includes the young brain of Matt Blea, who nearly died on a California football field close to two years ago.

On Thanksgiving Day 2009, Matt, a 16-year-old junior and starting running back for San Jose High, tried to retrieve an underthrown ball during the opening possession of the 66th annual Big Bone rivalry against Lincoln High. Despite his modest five-foot five-inch, 140-pound frame, Matt was the recipient of all-league honors as well as props from an opposing linebacker, who once told him, "I don't know how you ran me over, because you're so little."

As Matt jumped for the errant pass, a Lincoln High safety cleanly and legally put his shoulder into Matt's midsection. Because he was unable to brace himself, Matt's head whiplashed against San Jose City College Stadium's artificial turf.

"I knew instantly something was wrong," says father and former San Jose defensive coordinator Dave Blea, who stood on the sidelines. "I couldn't see his pupils. I could only see the whites of his eyes."

Out of sight of the referees, who signaled play to continue as normal, Matt crawled to the sidelines and lost consciousness. After paramedics tried unsuccessfully to revive him, Matt was rushed to Santa Clara Valley Medical Center for emergency brain surgery.

"They didn't think he was going to make it," says Dave about his son, who remained comatose for ten days. "They thought that he had suffered so much brain damage that he probably would have been mentally disabled."

Matt would spend nearly a month in intensive care due to complications from second-impact syndrome. His first concussion, suffered three weeks before on the second-to-last play of a game, was not detected, even after Dave took Matt to the doctor when he told his father that he felt blurry.

"One thing that still hurts is that I always told my kids that if they suffered a concussion, I would keep them out the whole year," says Matt's father. "He passed all of his neurological tests. I guess he was misdiagnosed."

Matt suffered another setback when the surgical incision became infected, requiring another procedure to remove a piece of his skull. For the next 42 days, Matt was forced to wear a helmet and take a chemotherapy-like cocktail of antibiotics.

"I don't remember much at the hospital," says Matt, who was paralyzed on the right side of his body for more than a month. "I remember people holding me up while I tried to take my first step, but my body felt like there was nothing there, like a ghost."

To the surprise of the physicians, Matt eventually recovered. Soon, the high-school graduate will attend De Anza College in Cupertino, California, to start a hoped-for career in physical therapy, a profession he never considered until after his injury. His first choice was to become a paramedic, but he's been told that's impossible. That's because his right eye remains half-blind.

Dr. Mark Ashley — co-founder, president and CEO of the Centre for Neuro Skills, whose clinics in Bakersfield, California, and Irving, Texas, specialize in traumatic brain injury rehabilitation — is currently helping Ali Champness recover from a number of serious health issues spawned by the not-too-dramatic hits from a soccer ball in January.

Champness, based on Ashley's advice, sat out the rest of the soccer season. Two months later, she joined the school's swim team. But three weeks in, Ali called her mom from a competitive meet in a panic. "Mom, you need to get me to a doctor," Kim Champness remembers her daughter saying.

At Ashley's center, an MRI and CAT scan revealed bleeding in Ali's brain. A cardiologist found that the initial concussion had deregulated Ali's autonomic nervous system. For months, whenever Ali jogged on the treadmill, her heartbeat soared high enough to trigger cardiac arrest or stroke. She still goes to rehab three hours a day.

One of Ashley's most severe cases, treated at the Centre's Texas facility in 2006, was a 13-year-old football player from the Seattle suburbs named Zackery Lystedt, called "Ray Ray" after his idol, rampaging linebacker Ray Lewis.

In the second quarter of a game, Zack fell backwards after an unremarkable tackle and hit the back of his head, although the injury escaped the notice of his father in the stands. "I thought he had gotten the wind knocked out of him," recalls Victor Lystedt.

Zack played every down for the rest of the game, even forcing a fumble and sprinting to a 32-yard return. But when his dad met him after the game, Zack started stumbling and muttering, "My head hurts really bad."

He collapsed onto the field. His left eye suddenly "blew out" and turned an inky black, the result of blood swelling in his skull. And then he convulsed into dozens of strokes. Says Victor, who witnessed the spectacle, helpless and confused, "My boy was dying on a football field." His son would survive, but his serious health problems continue to the present day.

Concussive episodes in youth aren't limited to soccer and football players, says Dr. William Jones, a staff physician at the Memorial Hermann Sports Medicine Institute in Houston. In recent years, Jones has witnessed a staggering increase in concussions, due partly to better detection, in high-school cheerleaders and ten-year-old gymnasts.

Because of this, school districts en masse are adopting new procedures for dealing with blows to the head. The most popular is the ImPACT test. A simple computer program designed by a pair of Pittsburgh doctors in the early 1990s, the exam finds an athlete's "baseline" — his mental aptitude and quickness of reflexes when he's not suffering concussive symptoms — which can be used later in a comparative test to see if a collision has caused a lag.

But the test has hit real-world snags. The first is its price: At packages costing roughly $600 per school for the first year, ImPACT is deemed too expensive for some districts. And even when they spring for the program, few schools can afford to pay a specialist to administer it. That duty tends to fall on coaches or trainers, who are often unqualified to conduct the test. As shown in a litigious case in the 'burbs of New York City, the results can be tragic.

In 2008, Ryne Dougherty, a 16-year-old high school linebacker in Essex County, New Jersey, sat out three weeks following a concussion. But after taking an ImPACT test, he was cleared to play. During his first game back, he suffered a brain hemorrhage and slipped into a coma. Ryne died within a week.

But Ryne's ImPACT results were ominously low, the family has claimed in a lawsuit against the school district. Additionally, according to the test results, Ryne reported feeling "foggy," but he was still cleared to play.

"Fogginess is the lead predictor of lasting head trauma," says Beth Baldinger, the attorney representing Ryne's family in a suit against the district. "[The trainer] ignored the test results in front of her. This case screams ignorance."

Michele Chemidlin, the trainer who administered the test, ignored phone messages and an e-mail requesting comment for this story. She claimed to Sports Illustrated that Ryne's test was interrupted by a "disruptive" teammate, which made the results "invalid." But Baldinger claims that the trainer retracted that story in a recent deposition.

"She testified that she never even bothered to see Ryne's test results," says the attorney. "It was one of the most brutal depositions I've ever been involved in. She left the room crying several times."

Kenneth Podell, a Detroit neuropsychologist and one of the creators of ImPACT, declined to comment specifically on Dougherty's case. But he says that "in ideal circumstances," the test should be administered not by a trainer but by a medical professional.

"It's better than nothing," says UCLA's Hovda about ImPACT. "I don't mean any disrespect, but neuropsychological tests, which require responses and performance from individuals, are always going to have problems because there's always going to be variances."

One of those variances is that an athlete can cheat the system. In April, Indianapolis Colts quarterback Peyton Manning flippantly admitted he intentionally performs poorly on baseline exams. When and if he takes post-concussion tests, the results won't look as bad, which means he (or anyone else who employs a similar baseline-test strategy) may be able to return immediately to play. NFL Commissioner Roger Goodell later fessed up that concussion-test cheating is an issue the league needs to address.

Complicating head-trauma detection is a recently released Purdue University study that concludes that youth athletes who aren't clinically diagnosed with a concussion are still experiencing fundamental brain changes that may be detrimental.

For two seasons, three Purdue professors tracked every practice and game hit sustained by 21 Lafayette Jefferson High School (Indiana) football players. "That's when we started to see that about half of the kids had some level of easily measurable neurophysiological change without any concussion whatsoever," says Purdue's Eric Nauman.

"What we think is probably happening is that since these kids don't have any symptoms, nobody ever takes them out of the game or makes them sit. They probably keep racking up more and more hits and it tends to affect more and more of the brain."

Nauman and his colleagues are looking for funding so they can study soccer players, wrestlers and participants in activities that aren't usually thought of as dangerous. "Anecdotally, the cheerleaders at Purdue had almost as many concussions as the football players," says Nauman.
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"No bill is better than a bad bill," says Senator Dennis Jones, a working chiropractor who, in May, helped to kill a concussion law in Florida. "As chiropractors, we've been treating head injuries since 1931. The symptoms of a concussion are not that difficult to diagnose."

Florida is one of the only states to balk at concussion legislation for youth athletes, a nationwide trend that started in 2009 when Washington gave a thumbs-up to the Zackery Lystedt Law. A prototype for dozens to come, the act requires any athlete under 18 who suffers a suspected concussion to receive written consent from a medical professional before returning to play. (There is no similar federal law.)

In Texas, Natasha's Law, named after former soccer player Natasha Helmick, was signed by Governor Rick Perry in June after the Senate passed the bill by a 31-0 margin. And, beginning on January 1, 2012, Colorado's Jake Snakenberg Act will take the Lystedt Law one step further by requiring every coach in youth athletics to complete an online concussion recognition course.

Florida, however, recoiled from its own version of concussion safety because Jones (R-Seminole) was miffed that the language did not include the back-cracking set among "medical professionals."

David Goldstein, the Miami high school soccer player, even testified in favor of the bill in Tallahassee. Jones didn't help his cause, recalls David, by talking on the Senate floor about how standard MRIs can be used to detect concussions, which is a fallacy. Jones filed an amendment to include chiropractors. The house refused to vote on the amended bill; it died on the floor.

After suffering three concussions, David had been told by doctors to "wait it out, never play soccer again and good luck." It wasn't until he visited the University of Miami — one of the nation's top medical centers for head trauma in student-athletes — that David's injury wasn't treated as some unfathomable affliction. The doctors slowly worked him back to the point where he could return to soccer wearing a rugby helmet. Now 16, he's a starter on varsity.

David is the son of the CEO of Royal Caribbean Cruises and attends a $28,000-a-year high school. That prompts an obvious question: If his treatment by coaches and trainers was botched, something that could be prevented by a concussion law, what chance does a regular kid — one whose parents can't pay every specialist in town — possibly have?

David tried to do something about that. Last year, he organized a raffle at his school and wrote letters asking for cash until he had raised $35,000, which will be donated to the Miami-Dade school district. It will pay for three to four years of ImPACT tests for every public school in the county.

As more and more states enact concussion laws, medical professionals, athletic trainers and school administrators are wondering if these laws are actually going to help prevent a condition that's inherently difficult to detect.

"I think the law comes up a little short," says Saint Louis University head athletic trainer Anthony Breitbach about Missouri's Interscholastic Youth Sports Brain Injury Prevention Act, "because a lot of these symptoms are subtle and can be easily concealed by the athlete if he or she wants to play." Additionally, Breitbach estimates that since only half of the state's schools can afford to employ an athletic trainer (which echoes a nationwide trend), a lot of concussions will continue to go undiagnosed, even with the new law in place.

In Arizona, on the strength of Governor Jan Brewer's signature on House Bill 1521, the Mayo Clinic is offering free, online-based concussion tests to more than 100,000 high school athletes.

In June, the Mayo Clinic issued a press release stating that the Arizona Interscholastic Association had endorsed the baseline test, which was not true and caused an AIA attorney to threaten legal action. The two have since made up and are partnering to test all Arizona contact athletes during the 2011-2012 school year starting with football.

Steve Hogen, athletic director of Mesa Public Schools, had concerns with Arizona's law even before it passed. According to him, if he and his cohorts hadn't been vocal about the bill's language (which was consequently amended), the law would have placed an impossible load on them.

"It put the burden on us that we had to make sure that all Pop Warner football kids were tested. That's impossible. We can't do that," says Hogen. "What if an out-of-state group had come in and they didn't have this concussion testing? We wouldn't have had the resources to check."

Because a legal precedent has yet to be established on these new laws, attorneys are divided on how potential lawsuits will play out in a courtroom.

Steven Pachman is a Philadelphia-based lawyer who has advised numerous academic institutions and athletic entities about concussion litigation. Though Pachman declines comment about specific clients, a records search shows that he defended La Salle University in a lawsuit filed by the family of a former player. Preston Plevretes claimed that he had received severe brain damage because the school's nurse and a team trainer inserted him back into play too soon following a concussion. (La Salle settled out of court for $7.5 million.)

Pachman explains that he receives a call each week from advice-seeking youth and high school sports organizations, and "what I'm hearing from the defense perspective — 'We don't have a plan' and 'An athletic trainer is too expensive' — frightens me," says Pachman.

"The youth sports might suffer the most because of their lack of resources...A town of 80 people, like the one from Hoosiers, may not even think about potential litigation until something tragic happens," says Pachman.

Randall Scarlett of the San Francisco-based Scarlett Law Group admits that it's a "dismal state out there in terms of concussion protocols that coaches and others are to follow." However, Scarlett doesn't think there will be a deluge of lawsuits if and when the state's bill is approved. (California's concussion legislation has been in the works for the past two years, but, due to financial constraints, has not made it out of committee.)

"In California, you're not going to get litigation unless you get some pretty egregious facts because of the burden of proof and the lack of standards for non-physicians," he says.

Before concussion laws came into vogue, the mother of Demond Hunt Jr. took her son's coach and the local school district to task.

In 2008, Demond, a 16-year-old linebacker for East St. Louis High School (Illinois), collapsed on the sideline during a game. A blood vessel had burst in his brain, which sent Hunt into multiple seizures and strokes.

Earlier in the game, Demond, according to the lawsuit, had complained of a concussion-like headache to his coach, who told him in so many words to suck it up and keep playing. Prosecuting attorney Michael McGlynn, who refused to comment in detail, says the case is still pending.

The parents of Zackery Lystedt of Seattle also filed suit on their son's behalf. Airlifted to a Seattle ER on life support, Zackery had the top of his head completely removed by surgeons. He wasn't supposed to regain consciousness.

The milestones that have come since then have been both miraculous and frustratingly glacially paced. Nine months following the strokes, Lystedt resumed speaking. By 13 months, he moved his left arm. After 20 months, he could once again eat. Now, five years later, Zack, age 18, can walk a few steps with a cane. "You get a little bit back, you want a little bit more," says Victor Lystedt of his son's progress. "You never get satisfied, because you had it all before."

Zack's parents, whose lives have been completely altered as they have cared full-time for their son, sued the school district for allowing him to play through his injury. The district settled, with one of its lawyers shrugging off the payout as a "business decision."

That still offends his father. "Shame on those lawyers," says Victor. "They can all rot in hell as far as I'm concerned. There's nothing 'business' about my kid."
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Before she became an old woman at age 14, Kayla Meyer had three passions. She rode horses on her family's farm. She was a huge reader. "Supernatural monsters kind of thing," explains the gregarious Minnesotan when asked what books she likes, "or old kind of sword-fighting stuff is basically what I read."

And, like seemingly every other man, woman and child in the iced-over town of New Prague, 45 miles south of Minneapolis, Kayla played hockey.

In early 2009, then age 13, she was skating in a club game when a collision took her legs out from under her and she fell, hitting the back of her head. Kayla told the coach she was fine and played the rest of the game.

When she went to the nurse with a headache the next day, the nurse gave her aspirin. When her headache persisted, a doctor administered a run-of-the-mill CAT scan, which does not detect concussions. Nothing looked amiss, so she was cleared to return to the ice.

"I've been skating since I was four, at the pond near my house," explains Kayla. "It would've just felt weird not to play hockey."

Ten months later at a high school team practice, Kayla was doing a drill she calls "mountain climbers," a sort of butt-in-the-air pushup on skates. Exhausted, her arms slipped, and her forehead smacked the ice. The rest of the team skated to the locker room, unaware that she lay crumpled in pain. It wasn't until the next team found her in the rink that Kayla's mom, Mandy Meyer, received a frantic call to come to the arena.

Kayla's head hurt so badly in the next couple of weeks that her bewildered parents called a plumber to check for carbon monoxide leaks in their house. Her coach's solution, according to Mom: "Put a helmet on her. Let her skate through it."

Meyer's head was too sensitive for her to even bear a helmet. She hasn't played hockey since. A year and a half since that second concussion, she remains hobbled by excruciating headaches and a crippling intolerance to noise.

Kayla's ordeal illustrates a debate that's currently occurring in the medical community: How long should a concussed youth sit out before returning to athletic activities?

"Some people said ten days, others said three months," says the Medical Center's Jones about a medical conference that he recently attended. Meanwhile, Ashley sits somewhere in the middle. "We really need to be thinking seriously about waiting at least 30 days until a person with a concussion returns to play."

Natasha Helmick, along with licensed physicians, believes that concussed kids also need to take time away from academics in order to fully recuperate. Natasha says that while she recovered from her injuries, she refused to miss her classes at Allen High.

"Part of the reason why I'm so bad now is because I had a concussion and I played the next day and I went to school the day after that," she says.

As athletes ascend to high stakes university-level sports and academics, some are starting to wonder if the gamble is really worth it.

Born and raised in Santa Ana, California, Karoline "Kari" Krumpholz was destined for water polo greatness. Her father, Kurt Krumpholz, a three-time All-American selection in men's water polo, was inducted into UCLA's Hall of Fame in 2008, the same year that Kari's brother, J.W., won a Olympic silver medal with the U.S. water polo team.

As a sophomore at Foothill High School, Kari and her water polo team won the 2007 California Southern Section Division I championship. Following a star-studded career that included numerous athletic honors, she accepted a scholarship to UCLA.

During a UCLA practice in February, Kari was defending "one of the strongest girls on the team" when she got clocked between the eyes by her teammate's elbow. Kari thought her nose was broken, but upon further examination, a student trainer said she was fine. As a precaution, the trainer made her skip the rest of practice.

However, Kari wasn't doing so hot the next day. "I went to class and I knew something was wrong. I couldn't focus and I felt out of my body. I am a really good student so for that to happen, I knew something wasn't right."

That day, a doctor diagnosed her with a concussion. Five months later, in between nearly daily visits to various UCLA physicians as well as Orange County's Migraine & Headache Center, she's still experiencing symptoms.

To Kari's knowledge, this is the first concussion that she has received. "But since I've been having so many problems, one doctor said that it's possible that I had undiagnosed concussions in the past," she says.

If and when her symptoms clear, Kari, a sophomore majoring in psychology, sounds doubtful that she'll return to the water.

"It would be scary for me to play again because my brain is really important to me and I have plans for graduate school," she says. "Once I am cleared, I'm going to have to really examine if I'm willing to take that risk."

For those who decide to stick it out, they may be playing a game that could be significantly altered in the future. Arizona, for example, has considered eliminating kickoffs from high-school football because of the dangers inherent when players collide with each other at top speeds.

Other organizations are relying on updated helmet technologies to try and prevent concussions. Even though it's impossible to completely prevent head trauma in football, helmet manufacturer Riddell has, in the past 20 years, redesigned and released several types of helmets.

For the 2011 season, each varsity player for Houston-area football powerhouse Katy High School will don the pricey and brand-new Riddell Revolution Speed helmet, which costs anywhere from $236 to $1,030. The previous version, the Riddell Revolution, helped decrease concussions by more than 300 percent, according to Katy head athletic trainer Justin Landers.

Katy's football staff has the money to use ImPACT testing and state-of-the-art helmets. However, one thing Landers and his coaching staff can't control is the win-hungry culture of Texas high school football.

From early June to mid-July, with the hot Texas sun overhead, Katy players run sprints on an outdoor practice field and hit the weight room during a five-week summer fitness program. Around this time every year, several parents — who are desperate for their freshman enrollees to gain a competitive advantage — will call Landers to ask his advice on what type of helmet they should buy for their sons. Landers, the son of a helmet salesman, is freaked that these kids will go out on some random field with ill-fitting equipment and hurt themselves.

Landers is another athletic trainer who believes that the state's recently passed concussion legislation has its shortcomings and that "the judgment call on whether to pull a kid from play won't make the decision any easier," he says. "We would look foolish if we were to send a kid to the doctor and he didn't end up having a concussion. That would be a waste of time and money."

Four years ago, Landers told a varsity football player who had suffered a staggering three concussions in five months to go to the doctor toward the end of the regular season. The athlete, a key contributor to the Tigers' playoff push, was deemed unfit to continue playing football.

Though Landers realizes that the doctor's decision was probably the right call, he still feels like he screwed up.

"I still feel badly," says Landers through teary eyes, as if the incident had just happened yesterday, "because he'll never get to experience what it's like to play in a Texas [high school football] playoff game."
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Former hockey player Kayla Meyer, unable to take the clatter of hallways or lunchrooms at her Minneapolis-area school, gets to her classes five minutes late and leaves late as well. She's missed 75 school days in two years. She eats lunch alone. Once a popular girl, she has been abandoned by all but a couple of her friends, so now Kayla mostly hangs out with her mother's friends.

Her plan had always been to become a vet technician so that she could take over the family business, a dog kennel on their farm. But now Kayla can't take barking. She can't ride horses because the motion makes her sick. And when reading, she now has difficulty processing individual words on a page.

"I have reading glasses now, but I always forget them," says Kayla, "and then I can only stand reading without my glasses for a couple of minutes, before the pain gets too bad."

The Meyers don't have health insurance. Sending Kayla to specialists is leaching the family's finances. Though they try to keep it from her, she's noticed that the ATV and the horse trailer have gone missing, pawned by her parents for cash. Next will be the horses, and one day maybe the farm itself.

There's no end in sight for Kayla's condition. "The physical therapists used to give us targets," says Mandy Meyer. "'It will be two weeks, two weeks.' Now they don't give her targets, because she's missed so many of them."

Though Mandy declares that her daughter's concussion was "handled horribly inappropriately," she won't consider a lawsuit. "There are just too many people who messed up," she says, including herself in that assessment.

In April, Kayla testified in front of the Minnesota Senate Education Committee in favor of a concussion bill, which would educate coaches and trainers and restrict when students can return to play. The lights and noise of the Capitol in St. Paul were a gauntlet for Kayla, but the bill passed.

She doesn't blame anybody for her condition. "My coaches are awesome," she says. "They just weren't informed enough."

As parents, coaches and athletes try to find the proper balance between athletic participation and long-term health, Natasha Helmick, who's studying at Texas State University to be an athletic trainer, is still experiencing depression and focus issues.

Natasha says she still hasn't moved past the disappointment of that day when Texas State decided to pull her athletic scholarship. "My doctor told me that I should never play a contact sport again in my life. He said, 'Don't even go out and shoot with friends. That's how endangered your head is.'"

Natasha's brother Zachary plays club select soccer and has "moved up the soccer ladder faster than Natasha did," says their mother, Micky. This summer, Zachary participated in the U.S. Youth Soccer Olympic Development Program. If he keeps performing well, he could be handpicked from a pool of athletes to represent the country in national and international competition.

However, the 16-year-old, like his older sister, has suffered multiple concussions. Micky, mindful of her son's dream as well as his long-term health, says it will be a "difficult decision" to pull Zachary from soccer if he receives another head injury.

"He's aggressive out there. He plays a lot like [Natasha]. It's very scary for me," says Micky, who adds that an incident that she and her daughter witnessed at the Texas state Capitol has contributed to her fears.

After Natasha's initial testimony in front of the House of Representatives in Austin, she and her parents sat in a rotunda with former football players Robert Jones and N.D. Kalu. Jones won three Super Bowl rings as a linebacker with the Dallas Cowboys, while Kalu played ball at Rice University before embarking on a 12-year career with the Philadelphia Eagles, Washington Redskins and Houston Texans.

As the Helmicks engaged in idle chitchat with the group, they noticed that something just wasn't right mentally with these hulking athletes who had suffered countless concussions during their playing careers.

"When we left there for the day," says Micky, "Natasha turned to me and said, 'Mom, I could really tell. I hope I'm not that way when I'm their age.'"

Five years ago, former soccer player Natasha Helmick (left) once played a game half-blind after sustaining a concussion. Today, her mother Micky says that it takes her daughter three times as long to complete mental tasks.